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Tourniquets for All

Surgeon’s disaster preparedness mission
By Scott Warner

There’s a lesson to be learned from the battlefields in Iraq and Afghanistan that can be applied to the streets of Chicago. Chicago Medical Society member Raj Lal, MD, wants to bring that lesson home.

Dr. Lal, a cardiovascular thoracic surgeon, devotes some of his time to assisting health care organizations in disaster preparedness. He is a member of the Illinois Emergency Medical Response Team, and is a medical manager of the White Team of Illinois Urban Search and Rescue Task Force 1. In 2014, he participated in a conference sponsored by the Brazil Department of Defense where he spoke about “Care Under Fire.” Dr. Lal told his audience in Rio De Janeiro about the importance of first responders knowing how to apply tourniquets to soldiers who have sustained life-threatening injuries on the battlefield. “The most important step is to control hemorrhaging from extremity wounds: the immediate application of the tourniquet by the first responder, or even the victim himself, will accomplish this,” Dr. Lal said.

Acknowledging that armed forces medics know how to apply tourniquets and have learned much about combat casualty, Dr. Lal says he would like to bring this battlefield knowledge back home for civilian use. “Historically, many lessons learned from military casualty care have found applications in civilian trauma care. The challenge is how to replicate the experience of a military battlefield in civilian practice when you have an active shooting event,” Dr. Lal said.

“We have had multiple school and mall shootings across the United States, and terrorist events like the Boston Marathon bombings; we have gang warfare where a teenager lies shot in the leg and bleeding; a woman’s leg is nearly severed in an automobile accident; a building collapses and people are severely injured,” Dr. Lal says. “The main cause of death is bleeding from the extremities, and the golden hour is the first hour after sustaining an injury.”

Dr. Lal would like to see that first responders, including police, are trained in the use of tourniquets. “If a policeman is by himself and gets shot in the leg, he could even apply the tourniquet to himself before he goes into shock.” He would also like to see teachers, even students, and civilians trained in tourniquet use, just as civilians are trained in CPR. “It would be great if people would carry a tourniquet in their cars, just like they carry a flashlight in their glove compartment in case of an emergency,” Dr. Lal says. “It’s such a simple device, and so inexpensive. But it requires some basic training.”

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